Who Cares? Transforming Social Care in Scotland

03 Jul 2018

New models are needed that put power back in the hands both of people requiring care and support, and the professionals who provide it.

Edel Harris

Over recent years, with the emphasis on austerity and the resulting public service funding crisis, the social care sector in the UK has become an industry that in many cases has lost focus on the person requiring care and support. Time and tasks have become the order of the day with often stressed, low paid workers following a schedule that has more in common with a manufacturing production line.

The power sits with the commissioners of the service who are under enormous pressure to work within very restricted budgets. It is commonplace that care services are traded as a commodity to the lowest bidder and it has become increasingly rare that the price of that commodity includes a decent rate of pay for the person delivering the care.

New models are needed that put power back in the hands both of people requiring care and support, and the professionals who provide it. Models that personalise the support available, provide a fairer deal to carers, and offer value for money to commissioners.

Cornerstone is one of the largest social care providers in Scotland. We support 2,700 children, adults and families each year and our aim is ‘to enable the people we support to live a valued life, a life they choose’. We are implementing an ambitious strategy called Local Cornerstone that challenges traditional ways of providing social care, ensuring the power sits with the people receiving care and support.

We think our approach reflects some important shifts in power:

The power in personalisation.

Using tools available, such as Self-Directed Support (the Scottish government’s approach and tools for person-centred care and support planning), we are helping to put people who require care genuinely in control of how their allocated budget is spent. This helps to ensure they can live the life they choose.

The power in co-production.

Co-production and commissioning for outcomes is common language within the sector. However, we rarely see this happening in practice. Through the introduction of Local Cornerstone we are working with some brave and forward thinking Health and Social Care Partnerships in Scotland who are willing to relinquish some power and to take some risks in testing alternatives to traditional commissioning. For example, working with people supported by Cornerstone and their family members to make better use of self-directed support. The ‘contract’ is between the care provider and the supported person, not the commissioner, and based on outcomes not the trading of hours of care.

Putting power in the hands of frontline professionals.

Cornerstone has moved to a local branch structure made up of self-organising teams of up-skilled social care practitioners. This new model devolves autonomy and accountability to the frontline and empowers social care professionals to make decisions that can really improve the quality of care and support that is delivered. In addition, it ensures that through pay and other terms and conditions of employment there is a genuine demonstration that we value social care as a profession.

Making power and decisions more local and community-focused.

Power needs to be felt within local communities where one of the most intimate of transactions is delivered by people who are trusted to do a great job. To this end Cornerstone works in self-managing ‘neighbourhood teams’ who get to know their local area and are empowered and trusted to deliver what is needed. The Local Cornerstone model is inspired by our visits to other great organisations including Buurtzorg (the pioneering model of nurse-led care in the Netherlands). Local Cornerstone is gaining widespread interest across the sector: Cornerstone is one of the Scottish Government’s test sites for the introduction of 'neighbourhood care' to Scotland, and the implementation of the model is being independently evaluated to understand its effectiveness.

Power in new partnerships that go beyond commissioning statutory services.

We are keen to explore new partnerships between commissioners, local areas, service providers, and the voluntary and community sector. For example, through the establishment of the Cornerstone Foundation we are raising funds to enhance statutory provision and to do far more than we are contractually obliged to do.

Reflecting all these shifts in power, we believe that new approaches such as Local Cornerstone have the potential for significant positive impact across the UK social care sector.

Most importantly, we see the difference this new way of working has made to the individual lives of the people we support. We think that stories are particularly powerful, and our Storyteller in Residence is collecting stories to inspire others to change. Brian’s story reflects much of what we do, and why.

Brian was the main carer for his sister Elma, who had dementia. They lived together for many years, and as Elma’s health worsened Brian was there to do everything for her. Elma was assessed by a social worker and Cornerstone was asked to support her with three 30-minute visits per day, to ensure she was up, bathed, fed, taking her medication, and then supported to get into bed at night. Brian enjoyed the visits too because they gave him some respite and he would often take the opportunity to nip to the shops for a newspaper. He got to know the team of carers and valued the care they showed to his sister.

Sadly, Elma died quite suddenly. As a result the care package funded by the local authority ceased at the same time. The Cornerstone team recognised that Brian was grieving. He had become very isolated because of his caring duties. So even though the team were no longer contracted to provide care to Elma they agreed (with ‘Gift of Time’ funding from the Cornerstone Foundation) that they would continue to visit Brian, and actively encourage and support him to join social activities in the local community.

Brian is now a member of the local Men’s Shed and is playing bowls every week. He has re-kindled some friendships and his mental health has significantly improved. The Cornerstone team don’t see Brian so often now - and if they do pop their head in when they’re passing, they usually find that Brian isn’t at home!

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Edel Harris has been Chief Executive of Cornerstone, one of Scotland's largest charities, since 2008. Edel's background is in health promotion and she has significant experience in setting up and leading successful social enterprises and in developing new social care services